Patterns of Failure After Concurrent Bevacizumab and Hypofractionated Stereotactic Radiation Therapy for Recurrent High-Grade Glioma
Patterns of Failure After Concurrent Bevacizumab and Hypofractionated Stereotactic Radiation Therapy for Recurrent High-Grade Glioma
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DOI：
10.1016/j.ijrobp.2012.05.031
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发表时间：
2013-03-01
影响因子：
7
通讯作者：
Gutin, Philip H.
中科院分区：
文献类型：
--
作者：
Shapiro, Lauren Q.;Beal, Kathryn;Gutin, Philip H.
目的：贝伐珠单抗联合大分割立体定向放射治疗（HSRT）是治疗复发性高级别胶质瘤（HGG）的安全有效方法。本研究的目的是描述失败的模式后，这种治疗regiment.Methods和材料：24例患者复发性增强HGG治疗机构审查委员会批准的协议，同时贝伐单抗和再照射。对复发肿瘤行5次30戈伊的HSRT。每2个周期进行一次脑磁共振成像（MRI），根据Macdonald et al.的标准，贝伐珠单抗持续治疗直至临床或放射学肿瘤进展。进展时的MRI与HSRT治疗计划融合，并根据95%等剂量线内的体积对复发部位进行分类。根据患者的特点，肿瘤分级，复发模式，和最佳治疗反应的结果进行了分析的Kaplan-Meier方法。结果：22例患者经历了临床或放射学进展。15例（71.4%）复发肿瘤强化，6例（28.6%）无强化。11例（52.4%）患者在放射野内复发，5例（23.8%）患者在放射野外复发。增强模式和失败的位置与总生存率或无进展生存率无关。放射学反应是唯一的变量显着相关的无进展survival.Conclusions：尽管有前途的初步反应，除了HSRT贝伐单抗作为补救治疗复发HGG，大约一半的患者最终仍然经历失败的辐射领域。在挽救治疗中，加用HSRT的局部失败率似乎低于单用贝伐珠单抗。我们的数据强调了HGG的放射抗性和更好的挽救治疗的必要性。(c)2013 Elsevier Inc.
Purpose: Concurrent bevacizumab with hypofractionated stereotactic radiation therapy (HSRT) is safe and effective for the treatment of recurrent high-grade gliomas (HGG). The objective of this study was to characterize the patterns of failure after this treatment regimen.Methods and Materials: Twenty-four patients with recurrent enhancing HGG were previously treated on an institutional review board-approved protocol of concurrent bevacizumab and reirradiation. Patients received 30 Gy in 5 fractions to the recurrent tumor with HSRT. Brain magnetic resonance imaging (MRI) was performed every 2 cycles, and bevacizumab was continued until clinical or radiographic tumor progression according to the criteria of Macdonald et al. MRI at the time of progression was fused to the HSRT treatment plan, and the location of recurrence was classified on the basis of volume within the 95% isodose line. Outcomes based on patient characteristics, tumor grade, recurrence pattern, and best response to treatment were analyzed by the Kaplan-Meier method.Results: Twenty-two patients experienced either clinical or radiographic progression. Recurrent tumor was enhancing in 15 (71.4%) and nonenhancing in 6 (28.6%) patients. Eleven patients (52.4%) had recurrence within the radiation field, 5 patients (23.8%) had marginal recurrence, and 5 patients had recurrence outside the radiation field. Pattern of enhancement and location of failure did not correlate with overall survival or progression-free survival. Radiographic response was the only variable to significantly correlate with progression-free survival.Conclusions: Despite the promising initial response seen with the addition of HSRT to bevacizumab as salvage treatment for recurrent HGG, approximately half of patients ultimately still experience failure within the radiation field. The rate of local failure with the addition of HSRT seems to be lower than that seen with bevacizumab alone in the salvage setting. Our data underscore the radioresistance of HGG and the need for better salvage treatments. (c) 2013 Elsevier Inc.